Blog post written by Dr Katey Warran
On Tuesday 25th February 2025, 3-5pm, I facilitated a session for the Theory in Sociology Series led by CRITIQUE (Centre for Ethics and Critical Thought) in the School of Social and Political Science. The topic for the session was: Deconstructing hierarchies of knowledge: Are we at a gridlock? The event included presentations from four speakers (Amy Chandler, Niamh Moore, Shaira Vadasaria, and myself), and in this blog I summarise the content I presented to frame the event and discussion. I explore the rise of scientific authority and critically discuss the medical hierarchy of evidence and its application to the field of arts and health.
Why discuss hierarchies of knowledge?
Certain ways of knowing are valued more than others in different contexts. Within different disciplines, cultures, or groups, there are different trends regarding the kinds of knowledge and knowledge-making that are given credibility. And the value given to different types of knowledge will also affect how knowledge is mobilized beyond the contexts in which it was originally created. Within policy contexts, for example, these underlying assumptions influence what counts as ‘evidence’ and what will go onto inform policy and decision-making.
In many contexts and disciplines in the West, knowledge founded upon ‘science’ has tended to be given the greatest weight. Philosopher Stephen Toulmin has discussed the development of this trend towards scientific authority as linked to a kind of rationality that was constructed out of the Enlightenment (see Belfiore & Bennett, 2010). He argues:
"Certain methods of enquiry and subjects were seen as philosophically serious or “rational” in a way that others were not. As a result, authority came to attach particularly to scientific and technical inquiries that put those methods to use." (Toulmin, 2001, p.15, in Belfiore & Bennett, 2010).
While scientific advancement has been important and useful for many things, the challenge, as political philosopher Jason Blakely has noted, is that all forms of knowledge end up being crammed into its conceptual boxes, assumptions, and standards. He argues that:
"The abuse of popular scientific authority has had catastrophic consequences, contributing to the 2008 financial crisis, the failure to predict the rise of Donald Trump, increased tensions between poor communities and the police, and the sidelining of nonscientific forms of knowledge and wisdom." (Blakely, 2020)
One of the reasons for the continued authority given to science is its association with objectivity and positivism: scientific findings are often viewed as 'the truth'. But I would argue, as have many others, that science is a meaning-making system, made up of beliefs and values. Dominic Johnson & Michael Price have made this argument by comparing science as a meaning-making system to religion. They question:
"Is the fulfillment of the deeply rooted human need for meaning unique to religion? Is it possible that science, and even atheism, have also come to function as meaning-making systems in today’s world? Are there particular social and environmental conditions today that favour science over religion … or religion over science?" (Johnson & Price, 2019)
And sociologist Jeffrey Alexander has also highlighted the importance of the non-empirical parts of scientific processes, highlighting that tradition also plays a role in scientific theorizing. He states that, “science – even when it is rational – vitally depends on tradition." (Alexander, 1987).
Exploring these issues in the context of arts and health
In research that explores clinical outcomes in some way, the medical hierarchy of evidence is often drawn upon, highlighting that expert opinion is the weakest form of evidence and RCTs, systematic reviews, and meta-analyses are the strongest. While its application and interpretation has evolved over time, and there are critiques, this hierarchy is usually considered the dominant framework in health research. And this hierarchy has had huge impact on how knowledge is understood in the field of arts and health. For example, in relation to arts therapies, it has been argued that “effectiveness is measured through standard clinical outcomes, such as measurable changes in health or quality of life, assessed in terms such as recovery time or quantities of drugs consumed.” (Crossick & Kaszynska, 2016 p.101)
And this focus on impact and measurement has translated into arts and health policymaking, drawing on wider trends towards evidence-based policymaking in cultural policy. In the Arts Council England strategy for creative health, they note that they aim to “make a better-evidenced case for investment” and that this case, driven by evidence, will hopefully increase “the likelihood of investment from the health sector.” (Creative Health and Wellbeing strategy, 2022). This understanding of what counts as evidence is constructed within the context of a society that prioritises scientific authority.
However, there have been many academic responses to the search for scientific evidence in arts and health. For example, Raw and colleagues argue:
"…the drive of some academics for evidence-based impact research in arts and health may be too narrowly focussed, and that the sector may be overlooking a fundamental weakness in the overall debate. Without some redirection of scholarly effort away from evidence gathering and towards analysing and theorising the practice in question, the basis for understanding and accepting the findings of impact studies will remain insubstantial." (Raw et al., 2012)
But Raw also argues that there is a clear roadblock to shifting our understanding of evidence in arts and health. She says that “progress has been hampered by disagreement amongst academics about what constitutes evidence of value” (Raw et al., 2012).
Is co-production a way forward?
Some people within the field of arts and health have sought to address this roadblock and shift knowledge hierarchies using transformative frameworks that have also become popular in other disciplines (see Kara, 2020). For example, drawing on co-production or arts-based approaches. Perry outlines why this may be a suitable way to shift how we think about knowledge:
"Central to co-production is recognition of the inter-relationship between societal context and knowledge production, and a commitment to hold together both knowledge and action. The idea of contextualisation captures how science and society have become intertwined, and sites of knowledge production expanded, resulting in the delegitimation of traditional epistemic authority and expertise." (Perry, 2022, p.2)
Recognising that co-production may be one way to break down traditional epistemic authority, it feels a promising approach to opening up conversations about medical hierarchies of evidence that prioritise scientific authority. Co-production has very much made its way into the health and arts policy spaces, and many funders now require co-production. And there are a lot of celebratory narratives around co-production, not just in relation to its epistemological implications but because of its values of inclusivity and lived experience.
But if feels like somewhat of a contradiction that we are seeing these calls for co-production alongside the persistent re-enforcement of the medical hierarchy of evidence. Can these things really be compatible? And is meaningful co-production feasible in current economic times that tend to uphold a need for evidence-based approaches? With colleagues here at the University of Edinburgh, while we advocate for co-production, we have raised concerns over whether it is indeed possible to deliver meaningful co-production in amongst the structural challenges of the academic system (Warran et al., 2023). Others have also pointed to the challenges of advocacy for co-production by funders which may lead to a more ‘tick box’ form of working. Perry summarizes this challenge as follows:
"The danger is that this [advocacy by funders] exacerbates the ‘hidden politics’ of co-production and perpetuates acts of participatory justification that bear little resemblance to claims for co-production as a more democratic form of knowledge production." (Perry, 2022, p.3)
So, in many cases, the potential of co-production to make change in how we view hierarchies of knowledge is still untapped when it comes to the realities of economy, society, and politics.
Are we at a gridlock regarding shifting knowledge hierarchies?
We have a wealth of literature advocating for change in terms of how we think about knowledge. In arts and health, many seek change through use of co-production, arts-based, and other transformative frameworks and approaches. But many aspects of society and academia seem to be making it hard to make sustainable real-world change on the ground. Is this because of the structural obstacles to implementing change, or is there also insufficient theorisation of this gap? How can we come together to amplify the critical discourses that exist within arts and health, and shift how we think and feel about hierarchies of evidence and what gets translated into policy? Our ongoing interdisciplinary work is looking at the role of sociology in this landscape, but I also wonder if there are other contexts and disciplines that could be drawn upon to support us to delve theoretically deeper into hierarchies of knowledge in arts and health.
The content summarised here was developed as part of the Theory in Sociology series. To learn more about the series, visit the CRITIQUE (Centre for Ethics and Critical Thought) website.
Comments